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International collaboration on
epilepsy surgery in Tunisia a model for the future
Introduction
 Epilepsy is a frequent neurological disorder
 Medication does not always work
If seizures> 2 years and 2 drug trials then the chance
of long term control of epilepsy with medication is
~10%
 Epilepsy have an adverse impact upon
 Work
 Education
 Driving
 Mariage
 Life expectancy
Introduction
 Epilepsy surgery : effective treatment for
medically refractory seizures.
 60–80% of patients with temporal epilepsy
become seizure free after resective surgery
 This technique, although effective, remains
limited in developing countries, creating a
significant ‘‘surgical treatment gap’’
Presurgical evaluation of epilepsy
 Identification of candidates eligible for
surgery : crucial step before surgery
 Established at the Neurological
Department of Charles Nicolle
Hospital (Tunis)
 Includes : detailed history, neurological
exam, brain MRI, scalp video-EEG
monitoring and neuropsychological tests
Video-EEG Monitoring
Seizure focus
•Continuous EEG recording with simultaneous video recording of the
patient clinical manifestations
•Objective: localization seizure origin and propagation
•Requires technical and medical competencies
Contribution of EUMEDCONNECT
EUMEDCONNECT network project
Length of video-EEG
Combination of Video and EEG
 large files causing problems in data transfer
Using in real time the high speed NECT backbone
network, a rapid access transfer of the video-EEG
recordings from Tunis to France was performed
Video-EEG recordings were then discussed
between the two Neurophysiological teams.
In cases of concordance of clinical,
neuropsychological, neuroimaging data and
video-EEG recording, the surgery indication
was then considered